Table Of ContentPediatric Oncology
Series Editors: Gregory H. Reaman · Franklin O. Smith
Stephan D. Voss
Kieran McHugh Editors
Imaging in
Pediatric
Oncology
Pediatric Oncology
Series Editors:
Gregory H. Reaman
Silver Spring, MD, USA
Franklin O. Smith
Cincinnati, OH, USA
More information about this series at http://www.springer.com/series/5421
Stephan D. Voss • Kieran McHugh
Editors
Imaging in Pediatric
Oncology
Editors
Stephan D. Voss Kieran McHugh
Boston Children’s Hospital Department of Radiology
Harvard Medical School Great Ormond Street Hospital for
Boston, MA Children
USA London, UK
ISSN 1613-5318 ISSN 2191-0812 (electronic)
Pediatric Oncology
ISBN 978-3-030-03776-5 ISBN 978-3-030-03777-2 (eBook)
https://doi.org/10.1007/978-3-030-03777-2
Library of Congress Control Number: 2019930552
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Preface
When the Series Editors for the Springer Verlag Pediatric Oncology Series
first approached us to consider developing a comprehensive text focused on
Imaging in Pediatric Oncology, we were enthusiastic. Not since 1992, when
Cohen published his text Imaging of Children with Cancer, has there been a
textbook dedicated to pediatric oncologic imaging. To be sure, there have
been numerous clinical pediatric oncology texts with chapters devoted to
imaging, as well as a variety of pediatric imaging textbooks with chapters or
sections describing the imaging features of particular tumor types, in addition
to textbooks focusing on radiology/pathology correlation in pediatric oncol-
ogy. But a comprehensive reference text that could serve both pediatric
oncologists and pediatric radiologists, and that focused primarily on the
imaging techniques used in caring for children with cancer, was lacking.
In approaching this project we had two major considerations: firstly, this
text was not simply to be focused on providing detailed discussions of the
role of imaging and the imaging characteristics for each individual cancer
observed in the pediatric age group—while of interest, there are ample other
reference materials devoted to these topics. Rather we chose to focus on the
imaging techniques available and currently in use, including guidelines for
response assessment, use of functional imaging techniques and molecular
imaging, as well as newer developments within the field of radiology.
Secondly, in an effort to appeal to a broad readership and to provide a bal-
anced perspective, we were encouraged to invite colleagues from both North
America and Europe to serve as chapter coauthors, taking advantage of the
insights and expertise of pediatric imaging experts active in multiple interna-
tional consortia, such as the Children’s Oncology Group (COG) and the
International Society of Pediatric Oncology (SIOP).
The result has been better than we could have anticipated. We were thrilled
by the willingness of so many of our colleagues from institutions around the
world to contribute their knowledge and expertise in putting together the vari-
ous chapters contained in this text. In many cases chapters were written
together by colleagues from both the USA and Europe, and that is a testament
to the close working relationships that have developed among pediatric radi-
ologists with a major interest in oncology. The result is a series of contribu-
tions that span the breadth of pediatric radiology as it relates to the imaging
of children with cancer. All of the authors are well-known leaders in their
respective fields, and most also contribute their imaging expertise and knowl-
edge by being active in ongoing clinical trials. By inviting input from both
v
vi Preface
North American and European institutions, we feel we have been able to pro-
vide a varied perspective on the different approaches to imaging, particularly
as it is used in the context of both North American and European clinical tri-
als. In another edition we will endeavor to make this effort an even more
global phenomenon with contributions from Australasia and hopefully else-
where also.
The text initially focuses on technical aspects of pediatric oncologic imag-
ing, and then moves into how the multiple imaging techniques are applied to
specific challenges inherent to the imaging of children being treated for can-
cer, such as assessing response to therapy and treatment-associated complica-
tions. Chapters focused on radiation safety considerations and on radiotherapy
are necessary in any text such as this, as are the sections related to interven-
tional techniques. We conclude with chapters focusing on emerging tech-
niques (molecular imaging) as well as on the use of imaging to guide new
clinical management paradigms, such as for screening patients with a cancer
predisposition syndrome, and considerations related to survivorship and
imaging surveillance.
Understandably, some topics could not be specifically addressed in this
text. For example, the topics of quality of life, ethical considerations, global
disparities, and communication with patients are all worthy topics, but beyond
the scope of this text. There is no doubt that differences in healthcare eco-
nomics between countries can and do influence how imaging is utilized and
which techniques are deployed in the management of children with cancer.
For example, whole body MRI is not currently reimbursed in the USA as
there is presently no CPT billing code. As such many institutions must either
forgo these exams or develop creative strategies for reimbursement. In most
Canadian and European centers, in contrast, whole body MRI is reimbursed
as with other examinations and there are no barriers to performing the studies
in the majority of patients.
We hope you will agree that a book such as this is long overdue and that
you find it to be a valuable reference and resource for imaging and imaging-
based therapy used in the care of children with cancer.
Boston, MA, USA Stephan D. Voss
London, UK Kieran McHugh
Contents
1 Imaging in Pediatric Oncology: New Advances
and Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Daniel A. Morgenstern, Carlos Rodriguez-Galindo,
and Mark N. Gaze
2 Imaging in Paediatric Oncology: Pitfalls, Acceptable
and Unacceptable Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Joy Barber and Kieran McHugh
3 PET/CT in Pediatric Oncology � � � � � � � � � � � � � � � � � � � � � � � � � � � 29
Lisa J. States and Stephan D. Voss
4 PET/MRI � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 63
Sergios Gatidis and Jürgen F. Schäfer
5 SPECT/CT in Pediatric Oncology � � � � � � � � � � � � � � � � � � � � � � � � � 75
Helen Nadel and Lorenzo Biassoni
6 Functional MRI: DWI and DCE-MRI . . . . . . . . . . . . . . . . . . . . . 91
Govind B. Chavhan and Paul D. Humphries
7 Whole-Body MRI in Pediatric Oncology . . . . . . . . . . . . . . . . . . . 107
Rutger A. J. Nievelstein and Annemieke S. Littooij
8 Contrast-Enhanced Ultrasound: The Current State . . . . . . . . . . 137
M. Beth McCarville, Annamaria Deganello,
and Zoltan Harkanyi
9 Tumor Response Assessment: RECIST and Beyond . . . . . . . . . . 157
Kieran McHugh and Simon Kao
10 Neuro-oncology: Assessing Response in Paediatric
Brain Tumours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Felice D’Arco, Kshitij Mankad, Marvin Nelson,
and Benita Tamrazi
11 Complications of Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Eline E. Deurloo and Anne M. J. B. Smets
12 Non-neurologic Late Effects of Therapy . . . . . . . . . . . . . . . . . . . . 223
Sue C. Kaste and Anurag Arora
vii
viii Contents
13 Complications and Pitfalls in Neuro-oncology Imaging . . . . . . . 253
Stavros Michael Stivaros, John-Paul Kilday, Bruno P. Soares,
and Thierry A. G. M. Huisman
14 Radioisotope Therapies: Iodine-131, I-131-MIBG,
and Beyond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Neha S. Kwatra, Marguerite T. Parisi, and Barry L. Shulkin
15 Interventional Radiology in Pediatric Oncology . . . . . . . . . . . . . 305
Derek J. Roebuck and John M. Racadio
16 Tumour Tissue Sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Sam Stuart and Premal Amrishkumar Patel
17 Radiation Treatment Planning in Pediatric Oncology . . . . . . . . . 323
Naomi A. Lavan and Henry C. Mandeville
18 Radiation Dose Considerations in Pediatric
Oncologic Imaging � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 335
Karen E. Thomas and Frederic H. Fahey
19 Pediatric Molecular Imaging � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 347
Benjamin L. Franc and Heike Elisabeth Daldrup-Link
20 Imaging of Children with Cancer Predisposition Syndromes . . 369
Sudha A. Anupindi, Ethan A. Smith, and Nancy A. Chauvin
21 Surveillance Imaging in Pediatric Oncology . . . . . . . . . . . . . . . . 387
Martijn V. Verhagen, Kieran McHugh, and Stephan D. Voss
22 Perspectives and Future Directions . . . . . . . . . . . . . . . . . . . . . . . . 405
Stephan D. Voss and Kieran McHugh
1
Imaging in Pediatric Oncology:
New Advances and Techniques
Daniel A. Morgenstern, Carlos Rodriguez-Galindo,
and Mark N. Gaze
1.1 Introduction more sophisticated and sometimes more costly
imaging investigations. These include the use of
The discovery of X-rays by Wilhelm Röntgen in various types of contrast, additional functional
1895 was translated with remarkable speed into MRI sequences such as diffusion weighting and
routine clinical practice. Less than 1 year later, arterial spin labeling, a wider choice of molecular
the world’s first radiology department was estab- imaging tracers, and image fusion with hybrid
lished at the Glasgow Royal Infirmary. One of the imaging platforms bringing together single pho-
earliest images was of a foreign body lodged in ton emission computed tomography (SPECT)
the esophagus of a 6-month-old boy, and thus and PET with CT and MRI. This bewildering
pediatric radiology was born [1, 2]. Since that range of imaging options brings with it a require-
time there has been astonishing progress in imag- ment to choose wisely, to get the most clinically
ing technology, including the development of important information from the smallest number
medical ultrasound in the 1950s and computer- of scans.
ized tomography (CT), magnetic resonance Radiologists have emerged from an initial
imaging (MRI), and positron emission tomogra- role, focused on the technical aspects of obtain-
phy (PET) from the 1970s to the 1990s. Over ing images and their interpretation, to become a
time, technological advances coupled with clini- vital part of the multidisciplinary team caring for
cal research have led to an expanding array of pediatric oncology patients. Imaging is now cen-
tral to the management of patients with a variety
of CNS and non-CNS solid tumors, including for
D. A. Morgenstern (*)
initial diagnosis, staging and risk stratification,
Division of Haematology/Oncology, Hospital for
Sick Children, Toronto, ON, Canada treatment response assessment, surgical and
e-mail: [email protected] radiotherapy planning, and surveillance both
C. Rodriguez-Galindo after completion of therapy and in patients with
Department of Global Pediatric Medicine, St Jude cancer predisposition syndromes. In addition,
Children’s Research Hospital, Memphis, TN, USA
children with all types of cancer are at risk of
e-mail: [email protected]
infective and other treatment-related complica-
M. N. Gaze
tions for which radiological investigations are
University College London Hospitals NHS
required. The new subspecialty of pediatric inter-
Foundation Trust, London, UK
ventional radiology is essential to modern pediat-
Great Ormond Street Hospitals for Children NHS
ric oncology, its practitioners undertaking a range
Foundation Trust, London, UK
e-mail: [email protected]; [email protected] of image-guided minimally invasive techniques
© Springer Nature Switzerland AG 2019 1
S. D. Voss, K. McHugh (eds.), Imaging in Pediatric Oncology, Pediatric Oncology,
https://doi.org/10.1007/978-3-030-03777-2_1
